Trauma is a well established cause of bruising and hematoma formation in patient's taking oral anticoagulants and there are some case reports of this occurring spontaneously but is this, as one would imagine a rare event ?
I would be most interested to learn of colleagues' observations.
Mayo Clinic has a good description:
https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/easy-bruising/art-20045762
“anticoagulants” – new agents/generic. We use a wide variety of anticoagulation as part of the dementia treatment once a patient is identified as having underlying condition(s) (hypercoaguable state, afib, stensois, as examples). Most generally once the GI system is secure (no helicobacter, erosions, polyps, ulcers) – then the skin will be the next target for prevention of bruising. Most elderly will also have an acquired disorder of coagulation – some antibodies/interactions that we do not have assay to evaluate for but surmise they are there. Protection and nutrition have become mainstay of treatment with great success. Often we have patients on triple anticoagulation (Coumadin/plavix/aspirin) – and long sleeve or protected clothing when they are active. Many of the areas of skin/damage/bruising is because of a sheer effect on the skin. When the skin is pushed or pulled – then they have issues, sometimes as simple as digging into their pockets or a dresser drawer. We identify the location of the bruising to help guide our evaluation. If it is located across dorsal arms, anterior legs, knuckles, or upper arm (blood pressure cuffs) – then we continue supportive care and redirection. Additional use of protein shakes 2x a day over a 6 month period has also improved the outcome in many – but it seems proper dressing with protective clothing is suggested. When/if we identify location of bruising to be deep muscle, buttocks, back, chest, groin, posterior legs, scalp, face – then we do a reevaluation of the coagulation cascade and medication compliance as something is missing and wrong. (Factor Xa inhibitors – thrombin inhibitors need more experience and “surprise” bleeding is messy) With Coumadin we are able to titrate INR from 0.9 to 3.6 at times for a successful therapeutic range.
Bruising in common in the elderly even in those without significant trauma due to skin thinning and fragility secondary to decreased elasticity and resilience as we age. Patients on anticoagulants are even more susceptible. Other causes include low platelet counts, abnormally high PT and/or PTT due to other causes. Bruising should be investigated if the elderly patient has bleeding gums, blood in stool/urine, or bruising in uncommon locations. Hope this helped.
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